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The Health Act 2006: Behaviour change in action?

The Health Act 2006 is a very dull title for an Act of Parliament which has had such a profound and universally beneficial impact on all our lives. It enacted the ban on smoking in enclosed places to which the public have access.

When I was training to be a solicitor in 1976, I shared an unventilated basement office with an etiolated, chain smoking Welshman. He chain smoked Gauloises and I went home every night with a bad headache, smelling like a kipper. His right to smoke – and the social acceptance of smoking – trumped my right to breathe. How things have changed! But why have they changed so much?

In the 1950s the UK had one of the highest rates of smoking and consequently one of the worst rates of death from lung cancer in the world. However, smoking began to decline in the 1960s and death rates began to fall from 1965. In 1979, 45% of the population smoked but by the 1990s that number had fallen to 30%. Between the introduction of the smoking ban in 2007 and 2010 it fell a further 9%.

There was much controversy at the time with dire predictions of damage to businesses, particularly pubs. Smokers argued that their human rights were being attacked. The tobacco industry complained that it was leading to a reduction in the number of cigarettes smoked and a significant rise in the number of people quitting. Fancy that!

So why has the smoking ban been such a success? Firstly, the time was right. Research at the time showed that there was very strong public support for the ban. It has been largely self-policing; note how quickly people react if anyone breaches the ban. That is because the reasons for the regulations are well-understood and the benefits are now clear, in the same way our air is now clear.

The smoking ban did change behaviour but it achieved it by building on and reinforcing longer running changes in behaviour and attitudes. It made it clear that the right to breathe trumps the right to smoke. In 1976 I didn’t feel able to assert my right to breathe clean air in our dank little office. In 2013, I don’t need to, because Parliament championed and legitimised my right not be harmed over the rights of others to harm me.

At INLOGOV we are very interested in behaviour change and how changing public expectations and behaviour can impact, both positively and negatively, on public services. Behaviour change has come to be seen as a’ quick fix’ for all sorts of perceived ills. The experience of the smoking ban shows that it is all much more subtle and complex than that. It also demonstrates that the right legislation, at the right time, can work with the grain of changing social attitudes and can help both to change the behaviour of the unwilling and to embed that changed behaviour in new social norms.

Catherine Staite is the Director of INLOGOV. She provides consultancy and facilitation to local authorities and their partners, on a wide range of issues including on improving outcomes, efficiency, partnership working, strategic planning and organisational development, including integration of services and functions.

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One thought on “The Health Act 2006: Behaviour change in action?”

There is a similar but much slower change occurring in relation to the balance between the rights of citizens relying on motorised ways of getting about and those of citizens who walk and cycle. Again the health benefits of cycling and walking factor into the shifting priorities of government when enforcing speed limits on motorised traffic, introducing lower limits and redesigning streets to allow greater shared access to urban streets, a trend now extending to rural roads – familiarly preceded by complaints from motorists adept at representing themselves as victims. I understand this. As a one time smoker I felt ‘got at’ by anti-smoking legislation and persuasion, thinking more of my ‘rights’ than those of others. We are only human!